1
|
S Oliveira S, G L Bandeira W, M Lopes L, R M Lima R, C Cavalcante J. Incidence of the tensor of the vastus intermedius: A cadaveric study. Morphologie 2024; 108:100609. [PMID: 37897940 DOI: 10.1016/j.morpho.2023.100609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 10/30/2023]
Abstract
INTRODUCTION The quadriceps femoris muscle is present in the anterior region of the thigh and is classically described as a muscle with four heads: rectus femoris, vastus lateralis, vastus medialis, and vastus intermedius. A few years ago, a "fifth head" was described and named the tensor of the vastus intermedius (TVI). The TVI belly is in line with the belly of the vastus lateralis, and its aponeurosis imposes considerable tension on the vastus intermedius, medializing its action, to play a significant role in knee extension. OBJECTIVE To perform a study of the TVI incidence in a Brazilian population and describe its variations. MATERIAL AND METHODS We dissected lower limbs from cadavers previously fixed in 10% formaldehyde, belonging to the Laboratory of Anatomy of the Department of Morphology of the Biosciences Center of the Federal University of Rio Grande do Norte. RESULTS Eighty-one lower limbs were analyzed with only 33 (40.74%) of them presenting TVI. All four types of TVI described by the literature were present in our sample with the following distribution: type 1 with 15.15%; type 2 with 9.1%; type 3 with 33.33%; type 4 with 42.42%. DISCUSSION Although the literature points to the TVI as a normal belly of the quadriceps, making it a "quinticeps", our analysis points to the TVI as a variation and probably a matter of regionality. However, the presence of TVI is not a rare case and cannot be disregarded, which makes this study important for anatomists, physiotherapists, physicians, and surgeons.
Collapse
Affiliation(s)
- S S Oliveira
- Department of Morphology, Biosciences Center, Laboratory of Anatomy, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - W G L Bandeira
- Department of Morphology, Biosciences Center, Laboratory of Anatomy, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - L M Lopes
- Department of Morphology, Biosciences Center, Laboratory of Anatomy, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - R R M Lima
- Department of Morphology, Biosciences Center, Laboratory of Anatomy, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - J C Cavalcante
- Department of Morphology, Biosciences Center, Laboratory of Anatomy, Federal University of Rio Grande do Norte, Natal, RN, Brazil.
| |
Collapse
|
2
|
Olewnik Ł, Ruzik K, Szewczyk B, Podgórski M, Aragonés P, Karauda P, Tubbs RS, Sanudo JR, Pires MB, Polguj M. The relationship between additional heads of the quadriceps femoris, the vasti muscles, and the patellar ligament. BIOMED RESEARCH INTERNATIONAL 2022; 2022:9569101. [PMID: 35224103 PMCID: PMC8866009 DOI: 10.1155/2022/9569101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 01/26/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The quadriceps femoris consists of four muscles: the rectus femoris, vastus medialis, vastus intermedius, and vastus lateralis. However, the effect of additional quadriceps femoris heads on the vasti muscles and patellar ligaments is unknown. The aims of the present study are to determine the relationship between additional quadriceps femoris heads and the vasti muscles and patellar ligaments and to review the morphology of the vastus lateralis, vastus medialis, and vastus intermedius. MATERIALS AND METHODS One hundred and six lower limbs (34 male and 19 female cadavers) fixed in 10% formalin were examined. RESULTS On all lower extremities, the vastus lateralis consisted of superficial, intermediate, and deep layers. The vastus medialis, on the other hand, consisted of only the longus and obliquus layers. The quadriceps head had one or more supplementary heads in 106 dissected limbs from 68 cadavers (64.1%). The distal portion of the patella was wider in lower limbs without supplementary heads than in type IA but narrower than in type IIIA. In general, the distal portion of the patella was narrower in specimens with a supplementary head than in those without (19.03 SD 3.18 mm vs. 20.58 SD 2.95 mm, p = 0.03817). Other patellar ligament dimensions did not differ significantly. CONCLUSION The quadriceps femoris muscle is characterized by high morphological variability. Occurrence of extra heads is at the level of 64.1%. The vastus lateralis consists of three parts (superficial, intermediate, and deep), and vastus medialis consists of two (longus and oblique).
Collapse
Affiliation(s)
- Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
| | - Kacper Ruzik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
| | - Bartłomiej Szewczyk
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
| | - Michał Podgórski
- Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Paloma Aragonés
- Department of Orthopedics Surgery, Hospital Santa Cristina, Madrid, Spain
| | - Piotr Karauda
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
| | - R. Shane Tubbs
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Jose Ramon Sanudo
- Department of Human Anatomy and Embryology, Facultad de Medicina, Universidad Complutense de Madrid, Spain
| | | | - Michał Polguj
- Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz, Poland
| |
Collapse
|
3
|
Anatomy, Morphology and Function of the Tensor of Vastus Intermedius: A Systematic Review. J Funct Morphol Kinesiol 2021; 6:jfmk6030077. [PMID: 34564196 PMCID: PMC8482252 DOI: 10.3390/jfmk6030077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/04/2021] [Accepted: 09/08/2021] [Indexed: 11/16/2022] Open
Abstract
The tensor of vastus intermedius is a newly discovered muscle that is located at the anterior compartment of the thigh. The aim of the present study is to report, assess and synthetize the existing evidence on the anatomy, variation and morphological characteristics of the TVI as well as to examine its clinical importance. A systematic review was performed evaluating both anatomical and medical imaging studies which provided information about TVI anatomy, prevalence, variations and morphological characteristics. The search strategy was conducted in major electronic databases. Two reviewers worked independently to screen all possible references via a title/abstract examination. Methodological quality was examined with the Anatomical Quality Assurance checklist. A total of 295 cadaveric knees were included in the nine studies where in 244 (82.7%) cases the TVI was identified. Based on this evidence, it appears that the TVI is located between the vastus lateralis and vastus intermedius. The muscle belly is located proximally, and it is combined with a broad and flat aponeurosis before forming a tendinous structure that is attached at the medial aspect of the patella. The TVI presented some morphological variations and complex muscle architecture that varied along its length. There is insufficient good quality evidence as more than half of the included studies were ranked as having a "High" risk of bias with various methodological issues. Higher quality studies are recommended to evaluate the TVI morphology to better understand its functional and clinical importance.
Collapse
|
4
|
Three-dimensional modelling of human quadriceps femoris forces. J Biomech 2021; 120:110347. [PMID: 33711598 DOI: 10.1016/j.jbiomech.2021.110347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 02/10/2021] [Accepted: 02/22/2021] [Indexed: 01/13/2023]
Abstract
Quadriceps intramuscular anatomy is typically described in two dimensions. However, anatomical descriptions indicate fascicles in the quadriceps may have a three-dimensional orientation. The purpose of this investigation was to quantify the maximum force generating capacity of the individual quadriceps' muscles in three dimensions. Muscle architectural parameters were obtained from three cadaver specimens (two female) and input into a geometry-based multiple fascicle muscle force model. Vastus lateralis, vastus medialis, and rectus femoris had partitions which could be defined based on differences in the sense and direction of fascicles between partitions. Vastus lateralis and rectus femoris were bipennate due to partitions sharing an aponeurosis. Vastus lateralis deep and superficial partitions exerted posterior- (maximum: -29 ± 5 N) and anterior-directed (maximum: 58 ± 15 N) forces on their shared distal aponeurosis. Rectus femoris medial and lateral partitions exerted medial- (maximum: -38 ± 17 N) and lateral-directed (maximum: 19 ± 12 N) forces on their shared proximal aponeurosis. All vastus medialis fascicles ran along the proximal-distal axis. However, fascicles arising near the lesser trochanter also ran along the superficial-deep axis, while fascicles arising from the linea aspera ran along the medial-lateral axis. Thus, vastus medialis could be divided into longus and oblique partitions. Due to the large pennation angle, vastus medialis oblique could exert maximum medial-directed (-219 ± 93 N) and proximal-directed (279 ± 168 N) forces at approximately -40° and -70° knee flexion, respectively, indicating dual roles for vastus medialis oblique dependent on knee flexion angle.
Collapse
|
5
|
Mendes Da Costa T, Leveille LA, Rosenbaum DG. Quads or quins? Atraumatic restricted knee flexion due to accessory quadriceps bands in children. Pediatr Radiol 2021; 51:435-440. [PMID: 33211185 DOI: 10.1007/s00247-020-04866-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/28/2020] [Accepted: 09/30/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Recent anatomical investigations have emphasized the variability in the knee extensor apparatus, with particular attention to a fifth component of the quadriceps femoris termed the tensor vastus intermedius or accessory "quinticeps femoris." Disorders of this structure have not been described in the pediatric imaging literature. OBJECTIVE To review the clinical features, pathoanatomy and imaging findings of children presenting with derangement of the accessory quadriceps femoris, with a particular emphasis on the utility of early magnetic resonance imaging (MRI) of the thigh. MATERIALS AND METHODS This is a retrospective analysis of 3 children, ages 3-10 years at presentation, who underwent imaging evaluation with subsequent surgically proven accessory quadriceps femoris muscles. Their clinical histories, including duration of symptoms, MRI findings, intervention and surgical outcomes, are reported. RESULTS All patients presented with progressive unilateral restricted knee flexion and had multiple imaging studies targeting the knee before diagnosis. Diagnosis in all patients was made on MRI of the thighs, which demonstrated a fusiform low signal intensity structure with muscle-like architecture arising from the anterior or anterolateral proximal femur and blending with the common quadriceps tendon distally. All patients underwent surgical release of the anomalous band with significant functional improvement. CONCLUSION In cases of progressive limited knee flexion without intrinsic pathology, an accessory quadriceps muscle should be considered as an extrinsic cause. Our experience demonstrated this to be readily identifiable on MRI, with symptomatic improvement following surgical release. Early recognition of this condition should prevent unnecessary intervention such as knee arthroscopy and the debilitating loss of flexion due to delayed diagnosis.
Collapse
Affiliation(s)
- Thomas Mendes Da Costa
- Department of Radiology, British Columbia Children's Hospital, University of British Columbia, 4500 Oak St., Vancouver, BC, V6H 3N1, Canada
| | - Lise A Leveille
- Department of Orthopaedic Surgery, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Daniel G Rosenbaum
- Department of Radiology, British Columbia Children's Hospital, University of British Columbia, 4500 Oak St., Vancouver, BC, V6H 3N1, Canada.
| |
Collapse
|
6
|
Olewnik Ł, Tubbs RS, Ruzik K, Podgórski M, Aragonés P, Waśniewska A, Karauda P, Szewczyk B, Sanudo JR, Polguj M. Quadriceps or multiceps femoris?-Cadaveric study. Clin Anat 2020; 34:71-81. [PMID: 32644202 DOI: 10.1002/ca.23646] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/07/2020] [Accepted: 07/07/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE The quadriceps femoris (QF) consists of four muscles: the rectus femoris; vastus medialis; vastus lateralis, and vastus intermediate. The tendons of all of these parts join together into a single tendon that attaches to the patella. The QF is a powerful extensor of the knee joint that is needed for walking. A growing number of publications have examined the fifth head of the QF muscle. There is no information about the possibility of other heads, and there is no correct classification of their proximal attachments. Further, the frequency of occurrence of additional heads/components of the QF remains unclear. METHODS One hundred and six lower limbs (34 male and 18 female) fixed in 10% formalin solution were examined. RESULTS Additional heads of the QF were present in 64.1% of the limbs. Three main types were identified and included subtypes. The most common was Type I (44.1%), which had an independent fifth head. This type was divided into two subtypes (A-B) depending on its location relative to the vastus intermediate. The second most common type was Type II (30.8%), which originated from other muscles: IIA from the vastus lateralis; IIB from the vastus intermediate, and IIC from the gluteus minimus. In addition, Type III (25%) was characterized by multiple heads: IIIA-two heads with a single common tendon; IIIB-two heads with two separate tendons; IIIC-three heads (lateral, intermediate, medial), and IIID-four heads (bifurcated lateral and bifurcated medial). CONCLUSION The introduction of a new classification based on a proximal attachment is necessary. The presence of the fifth, sixth, seventh, or eighth head varies.
Collapse
Affiliation(s)
- Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Richard Shane Tubbs
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA.,Department of Anatomical Sciences, St. George's University, True Blue, Grenada
| | - Kacper Ruzik
- Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
| | - Michał Podgórski
- Department of Imaging Diagnostic, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Paloma Aragonés
- Department of Orthopedics Surgery, Hospital Santa Cristina, Madrid, Spain
| | - Anna Waśniewska
- Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
| | - Piotr Karauda
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Bartłomiej Szewczyk
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Jose Ramón Sanudo
- Department of Human Anatomy and Embryology, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Michał Polguj
- Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
| |
Collapse
|
7
|
Unusual case report of seven-headed quadriceps femoris muscle. Surg Radiol Anat 2020; 42:1225-1229. [DOI: 10.1007/s00276-020-02472-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 04/11/2020] [Indexed: 11/30/2022]
|